CHAPTER 22

Quality Assurance and Performance Improvement (QAPI) is the structured path for an effective program to measure and ensure quality care and quality of life for nursing facility residents, outlined by the Centers for Medicare & Medicaid Services (CMS). The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, requires that all nursing facilities imple- ment QAPI to meet national quality standards. Registered dietitian nutritionists (RDNs) with clini- cal experience, especially those with education and experience in management, are assets to the QAPI process. The Academy of Nutrition and Dietetics Standards of Practice and Standards of Professional Performance (SOP/SOPP) for Registered Dietitians in Extended Care Facilities advocated the participation of the RDN in the QAPI process.

WHAT IS QUALITY ASSURANCE AND

PERFORMANCE IMPROVEMENT? QAPI is a data-driven, proactive approach to improving the quality of life, care, and services in nursing facili- ties. This process involves all members throughout the organization at all levels. QAPI helps to identify improvement opportunities, address disparities in systems or processes, develop and implement an improvement or corrective plan, and monitor the effects of interventions. QAPI combines two approaches to quality: quality assurance (QA) and performance improvement (PI). Typically, nursing facilities have set QA levels to meet regulatory standards; however, these levels may also exceed standards. QA is retrospective, looking back at why standards were not met. Although this does improve quality, efforts tend to cease when the standard is met.

PI (also called quality improvement) is a forward- looking, continual review of processes with the

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Quality Assurance and Performance Improvement

objective of preventing or decreasing the possibility of problems by identifying opportunities and approaches to remedy the causes of systemic prob- lems. The goal of PI in nursing facilities is to improve processes involved in health care delivery and resi- dent quality of life. Box 22.1 defines QAPI; Table 22.1 compares QA and PI.

BOX 22.1 What Is Quality Assurance and Performance Improvement?

● Proactive and ongoing; not just a program ● Adds PI to QA

Data analyzed; trends identified; and improvement projects conducted

● Critical and innovated thinking

● All employees, residents, and families involved ●

Leadership involvement stressed, with resources allocated

● Emphasis on front-line staff participation Individualized for each facility

An examination of how work is done in an organization: changing the culture

THE ROLE OF THE REGISTERED DIETITIAN NUTRITIONIST IN QUALITY ASSURANCE AND

PERFORMANCE IMPROVEMENT Every RDN should understand the principles of QAPI as well as facility performance improvement projects (PIP). Understanding QAPI and participating as a member of the interdisciplinary team (IDT) will increase the value of the RDN. These resources will allow the RDN to keep updated with mandated expecta- tions and provide forms to assist facilities with